Provider Demographics
NPI:1295399095
Name:CHICKASAW NATION DIVISION OF HEALTH
Entity Type:Organization
Organization Name:CHICKASAW NATION DIVISION OF HEALTH
Other - Org Name:CHICKASAW NATION DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING AND CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARIAH
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:580-272-5710
Mailing Address - Street 1:1904 CARL ALBERT BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-3491
Mailing Address - Country:US
Mailing Address - Phone:580-272-5413
Mailing Address - Fax:580-272-1307
Practice Address - Street 1:1904 CARL ALBERT BLVD STE B
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3491
Practice Address - Country:US
Practice Address - Phone:580-272-5413
Practice Address - Fax:580-272-1307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHICKASAW NATION DIVISION OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-26
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies